Incidence and predictors of extubation failure among adult intensive care unit patients in Northwest Amhara comprehensive specialized hospitals

Abstract

Extubation failure occurs in mechanically ventilated patients after planned extubation. It can cause increased mortality, length of intensive care unit stays, prolonged mechanical ventilation use, increased hospital costs, and increased need for tracheostomy. In Ethiopia, extubation failure is limitedly studied among adult patients admitted to intensive care units. Therefore, this study aimed to assess the incidence and predictors of extubation failure among adult patients in intensive care units. A multicenter retrospective follow-up study was conducted among 380 extubated patients from mechanical ventilation at the intensive care unit in northwest Amhara comprehensive specialized hospitals from May 1, 2021, to April 30, 2024. The data was collected randomly from patient cards using a simple random method with a pretested checklist. The data was entered using Epi-Data 4.6 and analyzed using STATA 17. The Kaplan-Meier curve was used to estimate the median extubation failure time. The Cox proportional hazard regression model analyzes the relationship between independent and outcome variables. The overall incidence of extubation failure was 2.64 (95% CI: 1.97-3.54) per 1000 person-hour observations. Forty-five (12.33%) of participants had developed extubation failure. Comorbidities (AHR: 3.92, 95% CI: 1.41-10.81), prolonged mechanical ventilation duration (AHR: 4.69, 95% CI: 2.04-10.80), GCS ≤ 8 with tracheal intubation (AHR: 4.10, 95% CI: 2.10-7.97), and positive fluid balance (AHR: 2.39, 95% CI: 1.23-4.62) were independent predictors of extubation failure. Extubation failure among adult patients admitted to the intensive care unit was high in the first 24 h after extubation. The risk of extubation failure was higher for those patients with comorbidities, prolonged mechanical ventilation, GCS ≤ 8 with tracheal intubation, and positive fluid balance. Therefore, clinicians should prioritize patients who have comorbid conditions, require extended mechanical ventilation, have a Glasgow Coma Scale score of 8 or lower with tracheal intubation, or exhibit a positive fluid balance.

Keywords: Extubation failure; Incidence; Intensive care unit; Northwest Ethiopia; Predictors.

Fig. 1

Schematic presentation of the sampling procedure used to select adult mechanically ventilated patients at ICUs in northwest Amhara comprehensive specialized hospitals.

Fig. 2

Incidence of extubation failure among adult patients at ICU in northwest Amhara comprehensive specialized hospital from May 1, 2021 to April 30, 2024.

Fig. 3

Cox-Snell residual allover goodness of fit test among adult extubated patients from MV in northwest Amhara comprehensive specialized hospital May 2021 to April 2024.

Fig. 4

Kaplan Meier failure function of adult extubated patients from mechanical ventilation admitted to ICUs in northwest Amhara comprehensive specialized hospitals from May 1, 2021, to April 30, 2024.

Fig. 5

Kaplan-Meier failure curve for comorbidities among adult extubated patients at ICU in northwest Amhara comprehensive specialized hospitals from May 1, 2021, to April 30, 2024.

Fig. 6

Kaplan-Meier failure function curve for the duration of mechanical ventilation among adult extubated patients at ICU in northwest Amhara comprehensive specialized hospitals from May 1, 2021, to April 30, 2024.

Fig. 7

Kaplan-Meier failure curve for GCS among adult extubated patients at ICU in northwest Amhara comprehensive specialized hospitals from May 1, 2021, to April 30, 2024.

Fig. 8

Kaplan-Meier failure curve for fluid balance adult extubated patients at ICU in northwest Amhara comprehensive specialized hospitals from May 1, 2021, to April 30, 2024.